Purpose of the study: to study the effect of the combination of valsartan and sacubitril on the indices of central hemodynamics in patients with coronary heart disease (CHD) within 2 years after revascularization. Material and research methods. The study included 320 patients with coronary artery disease who underwent coronary revascularization. All patients were divided into 2 groups: patients who received valsartan (group B, 160 people), patients who received ARNI - a combination of valsartan and sacubitrile molecules (group C, 160 people). At baseline and in dynamics after three months, at the end of the first and second years of follow-up after revascularization in patients with coronary artery disease systolic the blood pressure (SBP, mm Hg), diastolic blood pressure (DBP, mm Hg), heart rate in minute, the concentration of brain natriuretic peptide (BNP) in the blood were determined. Also, during echocardiography, the stroke volume of the heart, indexed to the body surface area (SI, ml / m2), the minute index (MI, ml / m2), the mean pressure in the pulmonary artery (PA, mm Hg) were determined. Research results. In the group of patients taking valsartan (group B), the relative dynamics of BNP concentration was -10.69 ± 0.55% by the 3rd month of observation, -21.24 ± 1.03% by the end of the 1st year, and -34, 39 ± 1.64% by the end of the 2nd year of observation. The inclusion of sacubitril in the therapy scheme contributed to a greater positive effect in reducing the BNP concentration: the relative dynamics of the BNP concentration was -10.30 ± 0.52% by the 3rd month of observation, - 21.91 ± 1.00% by the end of the first year of observation, and -39.28 ± 1.67% (p <0.05 significant difference with group B). By the end of the 1st and 2nd years of observation, the use of a combination of valsartan and sacubitril contributed to a more pronounced decrease in blood pressure (p <0.01), a more pronounced dynamics of MI (p <0.05) and a decrease in pressure in РA (significantly lower baseline indicators, p <0.05 and indicator in group B, p <0.01). Conclusion. The present study revealed a positive effect of revascularization and subsequent therapy of coronary artery disease with the inclusion of sacubitrile on the BNP concentration, blood pressure and mean pressure of pulmonary artery.
Analysis of risk factors and clinical-hemodynamic parameters of patients with ischemic heart disease and arterial hypertension. Among the risk factors encountered in the examined IHD +AH patients, smoking + obesity + alcohol coexistence was 50%, obesity + hypodynamics 23.6%, alcohol + smoking 17%, heredity + alcohol + smoking 9.44%. Patients experienced headache in 75% of cases, tinnitus in 64%, weakness in 59%, tachycardia in 45%, and dizziness in 41%. The VEM test was performed in both groups of patients, with a threshold of (99.8 ± 2.3) Wt in patients with IHD + AH and 10.9% in patients with IHD without AH (109 ± 3.8) Wt. was At the same time (load) the duration of stress was equal to the initial value in the group with IHD + AH (8.3 ± 1.8), while in patients with IHD without AH was 9.2 ± 2.3 and 10.8%.
The importance of ophthalmotonometry in the diagnosis of ocular pathology cannot be overestimated. Not you- There are doubts about the need for this study in patients of all age groups [1]. For example tonometry data in eyes with a cornea having a thickness in the center of more than 580 microns need to be corrected lowering (real IOP is lower than the obtained data) [2].
Среди анестезиологических проблем, связанных с лапароскопией у детей, выделяют главным образом, влияние на организм ребенка внутрибрюшной гипертензии. При лапароскопических вмешательствах существенное повышение внутрибрюшного давления вызывает разнообразные патологические эффекты на органы и системы, в особенности, на гемодинамику и дыхание, а также на функцию печени, почек и кровоснабжение органов брюшной полости. Повышение ВБД приводит и к росту внутригрудного давления за счет смещения диафрагмы вверх, что уменьшает объём грудной клетки и дыхательный объём. При этом повышается пиковое давление в дыхательных путях, растет сопротивление легочных сосудов с нарушением соотношения вентиляция-кровоток.
Известно, что при наследственных формах заболевания часто наблюдается сочетание врожденной глаукомы с другими аномалиями глаза - аномалией Аксенфельда - Ригера, синдромом Франка - Каменецкого, аномалией Петерса, склерокорнеа (Bremond-Gignac D. 2007). Считается, что при глаукоме, сочетающейся с аномалиями глаза и синдромами, в отличие от гидрофтальма внутриглазное давление (ВГД) чаще повышается в более старшем возрасте, а именно во втором десятилетии жизни (юношеская глаукома), реже - после 5-6 лет и еще реже - в младенчестве (Катаргина Л.А., Хватова А.В., Коголева Л.В., и др.2010).
The most important stage of anesthetic management is the period of induction into anesthesia, which requires control and regulation of central hemodynamics and vegetative changes, which creates conditions for ensuring a smooth course of subsequent stages of anesthesia without increasing intraocular pressure during surgical correction of congenital glaucoma in children.
In adults under the age of 40 years, there was a tendency to increase mean blood pressure throughout the entire period of toxemia. The most significant changes in MAP were observed in group 3 on days 12, 24, 27, 29. A tendency to a decrease in the mesor of the circadian rhythm of MAP was revealed in burn toxemia in persons aged 71.3±7.0 years, which characterizes the predisposition to depletion of adaptive energy, sympathoadrenal resources. a direct relationship was found between changes in MAP and fluctuations in SBP in groups 1 and 3, as well as a direct relationship between changes in MAP and DBP in all injured patients and a negative effect of a hyperthermic reaction on MAP in patients aged 50.7 ± 7.1 years with a total burn area. damage 54.3±16.5%, grade 3 B 11.9±8.9%.
В современном мире, большинство случаев смерти связаны с неинфекционные заболевания (36 миллионов) и чуть более половины из них (17 миллионов) являются в результате сердечно-сосудистых заболеваний; больше одного- треть этих смертей приходится на взрослых людей среднего возраста. В развитые страны, болезни сердца и инсульта являются первым и второй ведущей причиной, смерть для взрослых мужчин и женщины. В связи с широкой распространенностью сердечно - сосудистых заболеваний среди населения планеты, каждый человек должен обращать внимание на факторы, которые подвергают его к заболеванию сердечно-сосудистыми болезнями. Факторы риска представляют собой индивидуальные особенности, оказывающие влияние на вероятность развития в будущем заболевания у конкретного человека.
The purpose of the study. Left ventricular end-systolic measurement (ChQSOO') and myocardial contractility index (MTI) and the relationship between cardiac contraction velocity (TsQT) and MTI development of a simple non-invasive method for characterizing myocardial contractility. Materials and styles. 33 children (21 boys, 12 girls) participated in the study. All patients underwent echocardiographic examination of the heart chambers, and systolic, diastolic and mean arterial pressure were studied. Results. The following linear relationship was found: MTI=20.1 (ChQSOO') +1.46 (r=+0.51; p<0.01); TsQT= -0.0075(MTI)+1.71(r= -0.48; p<0.01). Also, in echocardiography, the left ventricular wall and chambers volume standards were given. More than a century later, the Frank-Starling curvature relation is still in use.
The study of vitamin D - dependent risk factors for the formation of essential arterial hypertension
(EAH) based on the assessment of serum levels of calcidiol (25 (OH) D), calcium and vasoconstrictor factor endothelin-1-21 in 132 students aged 13 to 16 years (average age 14.64 ± 0.19 years) with normal, high normal blood pressure and essential arterial hypertension (EAH) established the priority effect of vitamin D supply on the level of diastolic blood pressure in the group of children with labile arterial hypertension and in the group of children with stable on the parameters of systolic blood pressure. In the mechanism of EAH formation in children, an interdependence between vitamin D deficiency and the severity of endothelial dysfunction by the level of endothelin -1-21 was revealed. The following vitamin D were determined by diagnostic efficiency - dependent risk factors for the formation of EAH in children in decreasing importance: endothein-1-21> 0.41fmol / ml; vitamin D <20ng / ml; Ca <2.22 mmol / L.
Optimization of diagnostics and schemes of pathogenetic intensive therapy of surgical sepsis in children based on clinical and laboratory criteria and bacteriological monitoring.Materials and methods: The research period is 2018-2020. The object of the study (n=73) – children with surgical pathology (widespread peritonitis, bacterial destruction of the lungs, post-traumatic brain hematomas, abdominal trauma, etc.). Research methods: microbiological monitoring to determine the sensitivity of the micro-organism to antibiotics was carried out before and at the stages of treatment (sputum, urine, wound, bron-choalveolar lavage, tracheal aspirate, blood, contents from drainages, wound surface). Determination of the sensitivity of the isolated strains to antibiotics was carried out by the disk-diffusion method. To determine predictors of sepsis in surgical patients, clinical (mean arterial pressure (mAP), heart rate (HR), respiratory rate (RR), SpO 2 , etc. and laboratory parameters on days 1–2 (up to 48 hours) of sepsis identification, days 4 and 8 of intensive therapy. Procalcitonin was determined by immuno-fluorescence on a Triage® MeterPro analyzer (Biosite Diagnostics, USA). Blood gases and electrolytes were analyzed using a Stat Profile CCX analyzer (Nova Biomedical, USA). Results: studies have shown the effectiveness of complex intensive care in 86.3 % of cases. Mortality was found in 13.7 % of cases. Patients with severe surgical pathology died: widespread peritonitis, severe TBI + coma with irreversible neurological disorders, urosepsis against the background of chronic renal failure, after repeated surgical interventions, due to the development of refractory septic shock (SS).
Conclusions. Early diagnosis of sepsis, rational early ABT under the control of microbiological monitoring, non-aggressive infusion therapy with early prescription of vasopressors (SS) with constant monitoring of the child's main life support organs contribute to an improvement in sepsis outcomes and a decrease in mortality
The monograph presents modern aspects of syndialysis arterial hypotension: solved and unresolved problems of predicting, preventing and diagnosing this complication during dialysis. The characteristics of clinical and pathogenetic features, diagnosis, treatment, prognosis and prevention of syndialysis arterial hypotension are given. The data of the dynamics of clinical, functional and laboratory studies of syndialytic arterial hypotension in patients on dialysis are presented. An algorithm for verifying the status of hydration and preventing syndialysis hypotension is presented. The monograph is intended for nephrologists, doctors of related specialties, masters and students of medical institutes.